Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

Important: Posts and information in this section are based on personal experiences and recommendations; they should not be considered a substitute for the advice of a healthcare provider.

Hey all. I started out on 300 mg of Gabapentin 3 months ago (June 1 after being diagnosed with RLS). Then after a few weeks the dose jumped to 600mg. I take my 1st capsule at dinner then my 2nd around 9. I was supposed to take this drug before bed but found I was getting uncomfortable sensations earlier.

Now I'm occasionally adding 300mg at 11pm because the 2nd 300mg cap had no effect and at those times I wake up with symptoms around 2am. Is this increase in medication common? Will I need to increase the dosage over and over? I'll inform my doctor (who had no problem with me increasing the dose to 600mg btw) and see what he thinks but thought I'd start yakking about my medication progress. Many of you have been through all this before.

Increasing the dosage of a drug in general is very common and especially with RLS developing a tolerance seems to be a huge problem that complicates treatment in many cases.

You most likely have to increase your dose for a while. Then you will either a point where you have a good effect and don't need to increase the dose any further, at least for a while like a couple of years or you will run into the problem that the dosage is still not enough but you can't increase the dosage anymore because of side effects or because your doctor doesn't want to prescribe a higher dose.

There are two more things about gabapentin that you need to be aware of. The first is that the half life for many is about 4-6 hrs, so it could be that it is simply being eliminated from the blood stream and you are having to take a dose during the night just to have enough to treat your RLS. The second thing about gabapentin is that it is only adsorbed into the blood stream by a short length of the small intestine. So, for some, this means that you can take higher and higher doses (more than where you are now), and none of it actually gets into the blood stream. The modifications that were made to Horizant were partly to address this limitation. Unfortunately, Horizant is MANY times more expensive right now.

600 is a rather low dose. I was told you could increase the dosage up to 1200. And yes, I've also experienced problems with tolerance and have to usually combine medications. I also exercise the best I can (have feet problems) and use a lot of mindfulness meditation which has been very effective with the restless leg. Another thing that really helps me is being on a high iron paleo diet. Iron is imperative to RLS sufferers like us and I eat high iron foods and take bloodbuilder 2 times a day and a gentle iron at night. So sometimes you may want other things to help offset the rls. But like everyone else, I need my meds too.

I like lyrica better than gabapentin, but it will increase the insomnia if you try to get off of it. I rotate the Gabapentin and lyrica, but there are less side effects with lyrica. However, I think there are less side effects if you try to get off gabapentin. I have tried Horizant and would get ill on it. Usually it takes a while to get the right medication combination.

Rustsmith wrote:There are two more things about gabapentin that you need to be aware of. The first is that the half life for many is about 4-6 hrs, so it could be that it is simply being eliminated from the blood stream and you are having to take a dose during the night just to have enough to treat your RLS. The second thing about gabapentin is that it is only adsorbed into the blood stream by a short length of the small intestine. So, for some, this means that you can take higher and higher doses (more than where you are now), and none of it actually gets into the blood stream. The modifications that were made to Horizant were partly to address this limitation. Unfortunately, Horizant is MANY times more expensive right now.

I'm thinking my RLS has been getting worse. Before I started on meds, symptoms would begin late just before bed around midnight and 300mg would see me through the night. Now I'm noticing mild symptoms around 7 or 8 so I start with 300mg at 6:00. My next 300mg is around 9 or 10 and one more at midnight to get me through the night. That's been working fine so far but it's only been a week. And yeah, I noticed that sometimes the dose make me very sleepy and sometimes not. Sometimes absorbed - sometimes not so much.

Brynmr wrote:Up to 1200 mg but it's been working well for over a month. Timing seems to be important. 600 mg at 5pm then another 600 mg at 9:30. I sleep through the night. Hopefully we're settled in for a while.

Should you become tolerant, you can increase the dose even higher. In Germany a dosage up to 4.800 mg / day is considered safe for teenagers and up to 3.600 mg / day per adult. So don't worry when 1,200 mg is not working anymore. As long as you tolerate the drug, there is some potential to increase the dosage.

Of course please speak with your prescribing physician before making any changes but I just wanted to you know that you have some options in case you should develop a tolerance.

Also when you tolerate Gabapentin but it is not working anymore, switching to Lyrica which is a more potent version of Gabapentin is also an option.

Gabapentin is a generic medication, which means that it is about as inexpensive as you are going to get. Lyrica can be pricey, but is still less expensive than Horizant. The patents on both Lyrica and Horizant are fairly new, so generics are not likely to become available anytime soon.

Still hanging in on 1200 mg a day with the occasional extra 300. I had a tooth extraction last week which meant taking hydrocodone for the pain. Wow! I could sit perfectly still for over an hour. That was interesting because I realized that my body is always moving in one way or another. Love that hydrocodone!

Wow! I could sit perfectly still for over an hour. That was interesting because I realized that my body is always moving in one way or another.

Isn't it interesting how we adapt to our situation so well that we don't know what "normal" is anymore? Only when we get a taste of the old "normal" do we realize how different our new "normal" is.

I'm glad the gabapentin is still a good solution for you. Have you tried eating more iron-rich foods? How did that work out?

You should probably get a full iron workup, including ferritin. Be sure to ask for ferritin levels to be checked (they're not always included). For WED/RLS patients, ferritin levels have a strong inverse correlation with symptom severity: low ferritin = worse symptoms. Ferritin is a protein that stores iron in the body tissues, and its level in the blood tends to drop when any tissue is lacking iron. WED/RLS patients have less iron in parts of our brains than we should;'and that comes out as low ferritin levels in the blood. Most of us with ferritin levels below 75 have worse symptoms. Most specialists agree that WED/RLS patients need to have ferritin levels of 100 or more.

I have an appointment in March so I'll request a test for ferritin levels then. I never gave it much thought because my doc brushed it off when I asked about that on my first appointment re: RLS. In the mean time I'll get a supplement for iron. Good advice I think - thanks Beth.